We report four cases of non-lethal intoxication with a mix of synthetic cannabinoid (AB-FUBINACA) and ecstasy. Four young (19- to 24-year-old) men were simultaneously admitted to the emergency department after sniffing an unknown white powder in addition of ecstasy consumption. One of them stayed in deep coma for one day, while the three others exhibited tachycardia, hallucinations and dizziness. Toxicological investigations (using immunochemical, LC-DAD, LC-MS/MS and GC-MS methods) revealed the presence of MDMA, MDA and amphetamine in urine and plasma samples collected on admission. A peak related to AB-FUBINACA (ABF) was detected by GC-MS screening and subsequently confirmed by LC-HRMS analysis. Plasma and urine ABF concentrations (determined using LC-SM/SM method) ranged from 1.6 to 44.3 µg/L and from 0.7 to 3.9 µg/L, respectively. Three ABF metabolites were identified using LC-HRMS in plasma and/or urine: an ABF carboxylic acid, a hydroxy-ABF and a hydroxy-desalkyl-ABF. This report emphasizes the need to investigate synthetic cannabinoids in intoxication cases of young patients.

"Chemsex" means sex, generally between men, occurring under the influence of drugs taken immediately before and/or during the sexual session. "Slam" is defined by injection of psychostimulant drugs in the same context. The Parisian Addictovigilance Center presents preliminary results of a specific harm reduction program for slammers and chemsexers, based on the analysis of new psychoactive substances (NPS). Study was built by stages: (1) questionnaire of evaluation on chemsex practice, (2) toxicological analysis of collected drugs samples, (3) communication of results during Focus Groups with impact assessment. From January to September 2016, 17 questionnaires on chemsex practice and 31 samples were collected. Fifteen participants out of 17 were slammers. Motivations were mainly disinhibition and seeking pleasure (14 mentions) or prolonging pleasure (11 mentions). Collected samples were presented as cathinones (alpha-PVP, 4F-PVP, PVP-8, 3-MMC, 2-MMC, 4-MEC, methylone, MDPV), other phenethylamines (2-FMA, methamphetamine, 3,4-CTMP, 3-FPM) and cocaine. Analytical results show a 90% adequacy between the announced substance and the identified molecule. The Focus Group revealed a final level of knowledge on the harm reduction questionnaire at 9.4 on a scale of 12 items with a positive impact on: opinion on sample analysis (+ 1 point at the end of the session) and knowledge of the products (+ 0.6 points). This study is still ongoing and the final results should allow the implementation in routine practice of a validated approach of harm reduction in this specific population.

ENGLISH :
A collaborative case-control study was conducted in France in order to determine the prevalence of alcohol, cannabinoids, opiates, cocaine metabolites, amphetamines and therapeutic psychoactive drugs in blood samples from drivers injured in road accidents and to compare these values with those of a control population. Recruitment was performed in emergency departments of six university or general hospitals and comprised 900 drivers involved in a non-fatal accident and 900 patients (controls) who attended the same emergency units for a non-traumatic reason. Drivers and controls were matched by sex and age. Alcohol was determined by flame ionization-gas chromatography, drugs of abuse (DOA) by gas chromatography-mass spectrometry with the same analytical procedures in the six laboratories, and medicines by high performance liquid chromatography with diode array detection. Blood alcohol concentration exceeding 0.5 g/l (i.e. the legal French threshold) was found in 26% of drivers and 9% of controls. In the 18-27 years age range, alcohol was the only toxic found in blood samples of 17% drivers and 5% controls, leading to an odds-ratio (OR) of 3.8. A significant relationship was found between alcohol blood concentrations and OR values. All age groups confounded, the main active substance of cannabis, Delta(9) tetrahydrocannabinol (THC), was found in 10% of drivers and 5% of controls. In the less than 27 years old, THC (>1 ng/ml) was detected alone in the blood of 15.3% drivers and of 6.7% controls, giving OR=2.5, whereas there was no link between THC blood concentrations and OR value. THC was found alone in 60% of cases and associated with alcohol in 32%, with OR=4.6 between drivers and controls for this association. The difference in morphine prevalence between drivers (2.7%) and controls (0.03%) was highly significant (P